0462-800
ELECTRIC SERVICE PROVIDER REGISTRATION APPLICATION FORM

 ESP No.  ______________________

 Date Granted  ________________  

 

***PLEASE PRINT OR TYPE***

1.	Exact Legal Name of Registrant:

________________________________________________________________            

If registrant is conducting business in California under a fictitious business name, list all the names under which the registrant is doing business as (DBA) in California, and the date and county in which the fictitious business name statement was filed. (Attach additional page if necessary.) For each DBA, provide a copy of the proof of publication of the fictitious business name, or a copy of the certified fictitious business name statement. (See Business & Professions Code Sections 17910, 17917, 17926.)

________________________________________________  ___________________  ______________________________
                                     DBA                                                   Date                                County

________________________________________________  ___________________  ______________________________
                                     DBA                                                   Date                                County

________________________________________________  ___________________  ______________________________
                                     DBA                                                   Date                                County

________________________________________________  ___________________  ______________________________
                                     DBA                                                   Date                                County

2.	Current Address:

___________________________________________________________________________________________________
                                                                                   Address

___________________________________________________________________________________________________
                         City                                                      State                                             Zip Code

3.	Current Telephone Number:  ______________________________________________________________________ 

4.	Type of Ownership:

         Individual        Partnership        Corporation      Other

                   Limited Liability Company               Government Entity

Complete and mail this application
along with $100.00 certified check
(write 0462-800 on front of check) and complete fingerprint cards (see question no. 21) to:
State of California
Public Utilities Commission
Energy Division - ESP Registration
505 Van Ness Avenue
San Francisco, CA  94102-3298

 

        FOR CPUC USE ONLY

       Application Processed

 By:    ________________________

 Date: ________________________

 

      

INCOMPLETE APPLICATIONS
CANNOT BE PROCESSED

5.	If a non-California corporation, limited liability company, or limited partnership, attach a copy of the certificate from the California Secretary of  State permitting the entity to transact business in California.  (See Corporations Code Sections 2105, 15692, 17451.)

6.	  a.  If registrant is a corporation, the state in which the registrant is incorporated and

             date of incorporation:____________________________(State of Incorporation) _______________(Date) 

        b.  List names and titles of corporate officers.  (Attach additional page if necessary):

        ____________________________________________________________________________________________________
 
        ____________________________________________________________________________________________________

        ____________________________________________________________________________________________________

        ____________________________________________________________________________________________________

7.	If a partnership list all general partners.  (Attach additional page if necessary.)

      _____________________________________________________________________________________________________

      _____________________________________________________________________________________________________

      _____________________________________________________________________________________________________     

      _____________________________________________________________________________________________________

8.	If a limited liability company list all managers and/or officers and their titles.
(Attach additional page if necessary.)
                         
      _____________________________________________________________________________________________________

      _____________________________________________________________________________________________________     

      _____________________________________________________________________________________________________     

      _____________________________________________________________________________________________________

9.	If registrant has listed type of ownership as “government entity” provide a brief description of the government entity, and list the names and titles of the personnel responsible for managing the sale of electricity to residential and small commercial customers.  (Attach additional page if necessary.)

      _____________________________________________________________________________________________________

      _____________________________________________________________________________________________________

      _____________________________________________________________________________________________________     

      _____________________________________________________________________________________________________

10.	If registrant has listed type of ownership as “other” describe the type of ownership, list the names and titles of all managers or officers, and attach a copy of the document establishing the entity as well and the bylaws or similar governing document of the entity.  (Attach additional page if necessary.)

      _____________________________________________________________________________________________________

      _____________________________________________________________________________________________________

      _____________________________________________________________________________________________________

      _____________________________________________________________________________________________________

11.	 If the type of ownership is a corporation, provide a listing of the name and address of all persons or entities that directly or indirectly own, control, or hold the power to vote ten percent or more of the outstanding voting securities of the registrant. In the alternative, attach any report required by the Securities and Exchange Commission which details such an interest.

      _____________________________________________________________________________________________________

      _____________________________________________________________________________________________________

      _____________________________________________________________________________________________________

      _____________________________________________________________________________________________________

      _____________________________________________________________________________________________________

12.	List all of the names and addresses of all the corporate registrant’s affiliates in which the registrant owns, controls or hold five percent or more of the affiliate.  If this information is contained in any report required by the Securities and Exchange Commission, that report may be submitted in lieu of the information. See the “NOTICE” section for the definition of an “affiliate.”

      _____________________________________________________________________________________________________

      _____________________________________________________________________________________________________

      _____________________________________________________________________________________________________

      _____________________________________________________________________________________________________

      _____________________________________________________________________________________________________

13.	The street address and telephone number of the registrant’s principal place of business if
different from current address and telephone number listed in line numbers 2 and 3: 

       ____________________________________________________________________________________________________ 
                                                                              Street Address
 
       ____________________________________________________________________________________________________
                                       City                                                       State                                  Zip Code       

       ____________________________________________
                            Telephone Number

14.  a. Please provide a brief description of the electrical services you plan to offer.
 
       ____________________________________________________________________________________________________ 

       ____________________________________________________________________________________________________ 

       ____________________________________________________________________________________________________ 

       ____________________________________________________________________________________________________ 

       ____________________________________________________________________________________________________ 

       ____________________________________________________________________________________________________

	
	b. Check the box or boxes which best describe your business. (See P.U. Code Section 331.)

 Marketer      Aggregator        Broker     

c. Check the box or boxes which describe what customer classes you plan to serve. 

 Residential Customers       Small Commercial Customers       Other Customer Classes

d. Check the box or boxes which best describe the geographic area in which you plan to offer electrical services.

 Statewide				  Northern California Counties      

 Central California Counties 	  Southern California Counties 

e. Indicate the number of customers you plan to serve.				     ___________

f. Indicate the average number of kWhs you expect to provide per month.	     ___________

15.	Before you can apply to register as an electric service provider (ESP), you are required to execute a service agreement with each utility distribution company (UDC) in whose service territory you plan to do business. State the name of each UDC for which you have a signed UDC-ESP service agreement. Attach to this form an executed copy of each UDC-ESP agreement. 

	Name of UDCs: ____________________________________________________________________________________

16.	a. Provide the names and titles of the key personnel that are involved in the technical and                                              operational aspects of the business. 

       ____________________________________________________________________________________________________ 

       ____________________________________________________________________________________________________ 

       ____________________________________________________________________________________________________ 

 b. On a separate attachment, describe each key person’s experience in the sale, procurement, metering, and billing of energy sources or similar products, including the time period of such experience.

 c. If your company is not providing metering or billing services, provide the names of the companies who will provide those services on your behalf, and provide a description of their experience in those areas. 

       ____________________________________________________________________________________________________ 
		
       ____________________________________________________________________________________________________ 

       ____________________________________________________________________________________________________ 

       ____________________________________________________________________________________________________ 

17.	Has your company been authorized by the California Independent System Operator to act as a scheduling coordinator?  

 	   No         Yes        If yes, attach a copy of such authorization. 

18.  The name, title, address and telephone number of the person to whom correspondence or 
        communication regarding customer complaints or inquiries are to be addressed.

        ____________________________________________________________________________________________________
                                           Name                                                                       Title
       
        ____________________________________________________________________________________________________
                                                                                 Address

        ____________________________________________________________________________________________________
                                       City                                                 State                                                 Zip Code

        ____________________________    _____________________________    ______________________________________
              Telephone Number                          FAX Number                                   E-Mail Address
                                                                         (If Available)                                      (If Available)

  
19.  Name and Address of Agent for Service of Process:
      (Must Be Located In California)   (See Corporations Code Sections 1505, 15800, 17057, 17060.)

       Name:_____________________________________________________________________________________________

       Street Address:____________________________________________________________________________________

       City and State:_________________________________________________________ Zip Code:_________________ 

20.  Has the registrant or any of the general partners or corporate officers or director of the company or limited liability company managers or officers ever been convicted of any felony? 
        No         Yes        If yes, please explain on additional page.

0.	Within the last ten years, have any of these persons had any civil, criminal, or regulatory sanctions imposed against them pursuant to any state or federal consumer protection law or regulation?
      No         Yes        If yes, please explain on additional page.

21. Provide a full set of fingerprints of the registrant if an individual, all general partners, all officers and/or directors of limited liability companies, or of all corporate directors and officers, on the fingerprint cards included with this application.  Additional fingerprint cards may be obtained from the Commission.

NOTICE

Each ESP registered with the California Public Utilities Commission (CPUC) should be familiar with all the laws and decisions pertaining to the offering of electrical services to residential and small commercial customers in California. This notice mentions some of the provisions that the ESP must abide by. 
 
If your ESP registration application is approved, you are required to provide the California Public Utilities Commission (CPUC) with a cash (cashier’s check) security deposit in the amount of $25,000 or post a financial guarantee bond in favor of the CPUC in that amount. This deposit must be received by the CPUC before you sign up and initiate a direct access service request on behalf of a residential or small commercial customer. The deposit or financial guarantee bond shall be delivered to the Energy Division address listed on the first page of this form. In the alternative, the ESP may elect to open a customer trust account in a format approved by the CPUC’s General Counsel. Pending such an approval, the ESP must post the cash deposit or the financial guarantee bond. This deposit requirement is subject to change and may be increased once the CPUC adopts final standards regarding an ESP’s proof of financial viability. 

Unless you are an ESP who has been authorized by the California Independent System Operator to act as a scheduling coordinator, each registered ESP is required to submit to the Energy Division a copy of all of its scheduling coordinator agreements or a declaration from each scheduling coordinator that such an agreement has been signed. The agreements are to be submitted on or before the date when the ESP signs up its first residential or small commercial customer.     

If the CPUC adopts final standards regarding an ESP’s proof of technical and financial ability which differ from those set forth on this form, you may be required to supplement your registration information. 

Prior to signing up and initiating a direct access service request on behalf of any residential or small commercial customer, all registered ESPs are required to provide the potential customer with a written notice which describes the price, terms, and conditions of service. The notice shall include all of the elements required by Section 394.5, and the requirements set forth in the CPUC’s consumer protection decision, D.98-03-072. 

Every ESP who offers to sell electricity to end-use customers is required to disclose its electricity sources to those customers in accordance with Public Utilities Code Section 398.4 and as directed by the California Energy Commission.

Public Utilities Code Section 394.7 prohibits all ESPs from soliciting those residential and small commercial consumers whose names appear on the list that is maintained pursuant to that code section. 

In order to change the electricity provider of a residential or small commercial customer, all ESPs must follow the verification procedures set forth in Public Utilities Code Section 366.5.

Every registered ESP is required to submit on a periodic basis information regarding its standard service plans. This information is to submitted on the form adopted by the CPUC.

In addition to the $100 registration fee, you are required to pay the annual fee required by Public Utilities Code Section 394.3(b). This fee is assessed on each registered ESP on September 1st  of each year. 

For the purposes of this form, the following definition of an “affiliate” applies:

“Affiliate” means any legal entity in which five percent or more of the outstanding shares are owned, controlled, or held with power to vote, directly or indirectly either by the ESP or any of its subsidiaries; or by the ESP’s controlling entity or any of its subsidiaries; or by any company in which the ESP, its controlling entity, or any of the ESP’s affiliates, exert substantial control over the operation of the company or indirectly have substantial financial interests in the company which is exercised through means other than ownership.  For purpose of this definition, “substantial control” include, but is not limited to, the possession, directly or indirectly and whether acting alone or in conjunction with others, of the authority to direct or cause the direction of the management or policies of the company.  A direct or indirect voting interest of five percent or more by the ESP in an entity’s company creates a rebuttable presumption of control. 

Any material change in the information required by this form shall be provided to the CPUC within 60 days.  (P.U.Code Section 394.1(d).)

Submit the original signed form together with all required documents, and three additional copies.

DECLARATION

(If this registration form is verified outside of California, the verification must be made by an affidavit sworn or affirmed before a notary public.)

I, (print name and title) ___________________________________________________________ hereby certify that I am empowered to act on behalf of _______________________________________________ (registrant’s name) and to make this application on its behalf. I declare under the penalty of perjury under the laws of the State of California that I have read the above notice, that the above statements and information submitted in connection with this application are true and correct, and that any documents furnished in connection with this application are true and correct copies.

 Dated this ___________________________________________ , at _____________________________________________
                                               (date)                                                                  (place of execution)

 Signature:__________________________________________________________